A comprehensive view of sex-specific issues related to cardiovascular disease
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- © 2007 Canadian Medical Association or its licensors
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.
In this issue
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- Article
- Abstract
- Burden of cardiovascular disease in women and men
- Search strategy
- Cardiovascular disease
- Coronary artery disease
- Heart failure
- Atrial fibrillation
- Health-related quality of life
- Summary
- Knowledge gap
- Cardiovascular risk factors in girls and boys
- Search strategy
- Overweight and obesity
- Lipids and insulin resistance
- Blood pressure
- Smoking
- Diet
- Physical activity and sedentary behaviour
- Clustering of behavioural risk factors
- Critical analysis of studies
- Why are there sex differences?
- Cardiovascular risk factors in women and men
- Search strategy
- Overweight and obesity
- Physical activity
- Hypertension
- Diabetes
- Dyslipidemia
- Smoking
- Cardiovascular risk markers
- Socioeconomic status
- Critical analysis of studies
- Why are there sex differences?
- Summary
- Knowledge gap
- Differences in cardiovascular presentation in women and men
- Search strategy
- Sex differences in symptoms of ACS
- Sex differences in the diagnosis of ACS
- Sex differences in prodromal symptoms of ACS
- Evidence for sex differences in symptoms presentation
- Summary
- Knowledge gap
- Genetic and sex determinants of hypertension and CVD
- Search strategy
- Y chromosome
- X chromosome
- Autosomal chromosomes and sex differences
- Mitochondrial DNA
- Future research
- Why are there sex differences?
- Summary
- Knowledge gap
- Delivery of cardiac care in women and men
- Search strategy
- Acute myocardial infarction
- Secondary prevention after acute myocardial infarction
- Cardiac catheterization
- Cardiac procedures after acute myocardial infarction
- Cardiac procedure rates in all patients with CAD
- Critical analysis of studies
- Why are there sex differences?
- Summary
- Knowledge gap
- Outcomes of CVD in women and men — clinical trials
- Search strategy
- Acute coronary syndromes
- Summary
- Percutaneous coronary intervention
- Primary PCI and thrombolysis in ST elevation myocardial infarction
- Early revascularization in non-ST elevation myocardial infarction
- Summary
- Knowledge gap
- Coronary artery bypass graft surgery
- Summary
- Knowledge gap
- Heart failure
- Atrial fibrillation
- Outcomes of CVD in women and men — post-admission drug therapy
- Search strategy
- Acute myocardial infarction
- Heart failure
- Atrial fibrillation
- Critical analysis of studies
- Conclusions
- Footnotes
- REFERENCES
- Figures & Tables
- Responses
- Metrics
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